The Do s and Don ts of Designing an Active Shooter Exercise Indiana Hospital Emergency Preparedness Symposium Speaker William (Billy) Castellano Senior Tactical Instructor, Healthcare Active Shooter Program HSS EM Solutions Active Shooter vs. Hostage Situation Active Shooter: An Active Shooter is an individual actively engaged in killing or attempting to kill people in a confined and populated area; in most cases, active shooters use firearms(s) and many times there is no pattern or method to their selection of victims. Hostage Situation: Armed individual(s) holding one or more people against their will until specific demands are met 2017 HSS Inc. 1
Purpose of Training & Exercises To increase workforce awareness and prescribe actions to take in the event of an Active Shooter incident: 10% of those untrained will be ableto respond 10% of those trained will be unableto respond 80% CANbe trained for better response Trained staff not only respond better, but recover better Hospital Shooting Statistics 2006-2016 Shootings/Weapons discharges in hospitals: Incidents: 383 Deaths: 290 Injuries: 180 States Impacted: 47 Hospitals of all sizes (from 25 to 1000+ beds) Hospital Shooting Statistics 2016 At least 43 Incidents within 2015 Hospital Firearms Discharges by State Alabama Indiana Nebraska 1 South Carolina 1 Alaska Iowa 1 Nevada South Dakota 1 Arizona 2 Kansas New Hampshire Tennessee Arkansas Kentucky New Jersey Texas 3 California 1 Louisiana 3 New Mexico Utah Colorado 2 Maine New York 3 Vermont Connecticut Maryland 1 North Carolina 1 Virginia 3 Delaware Massachusetts 1 North Dakota Washington Florida 6 Michigan 1 Ohio 1 West Virginia 1 Georgia 3 Minnesota Oklahoma 1 Wisconsin 1 Hawaii Mississippi 1 Oregon 1 Wyoming Idaho 1 Missouri Pennsylvania 2 Washington DC Illinois Montana Rhode Island Involves at least 24 fatalities 2017 HSS Inc. 2
Hospital Shooting Statistics 2006-2016: Incidents by Year 60 50 Number of Incidents 40 30 20 10 0 2006 2008 2010 2012 2014 2016 Year Hospital Shooting Statistics 2006-2013: Hospital Size Background During the past decade, many states began requiring that schools hold lockdown or generalsafety drills, apart from natural-disaster preparedness exercises. A survey by the Government Accountability Office found that nearly two-thirdsof U.S. schools hold some form of active-shooter drills to teach kids and teachers how to react in the event that an armed intruder enters the school. 2017 HSS Inc. 3
Exercise Don ts Many experts, say recreating the chaos of a mass shooting is no way to prime for emergencies. There ends up being zero learning going on because everyone is upset and scared. Todd Fuller, a spokesman for the Missouri State Teachers Association in a recent WSJ article: o "Some of our members have found the drills overwhelming" o "Instead of saying, 'I'm ready to help now,' their reaction has been, 'I don't know what I will be able to do in this situation' " Exercise Complaints Okaloosa County Health Department (Florida): A Fort Walton Beach nurse filed a complaint to the state, over a drill at an Okaloosa County Health Department office. According to the complaint, employees weren't informed about the drill, which involved a police officer firing blanks, and many were "hysterical, crying and shouting. A health-department investigation concluded that no policies were violated, noting that the police officer portraying the shooter was accompanied by an employee holding a sign that read: "This is an exercise. The staff member thought she was having a heart attack and intends to file a lawsuit. "It was a traumatic experience for everyone except for the upper management who planned it," according to her lawyer. Exercise Complaints Heritage Park Care Center (Colorado): Staff member filed a federal lawsuit against the police and facility after an active shooter exercise. Forced into an empty room at gunpoint and begged for her life. Left so traumatized, complainant alleges she had to quit her job. Police believed management notified employees. 2017 HSS Inc. 4
Exercise Categories Discussion Games Operations Full-Scale Tabletop Functional Workshops Drills Seminars Building-Block Approach Discussion Based Operations Based SMART Objectives Specific Measurable Achievable Relevant Timely 2017 HSS Inc. 5
Characteristics of Good Objectives An objective should state whoshould do whatunder what conditions, according to what standards Clear, concise, and focused on participant performance Should contain: Action stated in observable terms Conditions under which Actions that will be performed Standards of performance Example Given a standard balance beam raised to a standard height, the student (attired in standard balance beam usage attire) will be able to walk the entire length of the balance beamsteadily, without falling off, and within a six second time span. Who Actions Conditions Standard Operations-Based Exercise Objectives Focus on integration of multiple entities at systemslevel and tactical-level. Example: Evaluate the ability of the hospital s incident management teamto activate essential decontamination personnelas a result of contaminated patients presenting to the facility in accordance with existing SOPs. Who Actions Conditions Standard 2017 HSS Inc. 6
How to Develop an Exercise Scenario Objectives Target Capabilities Scenario How to Develop an Exercise Scenario Determine a threat/hazard: That best fits exercise objectives Is based on realistic threats Is of sufficient magnitude and realistic Use the organization s Hazard Vulnerability Analysis Identify player activities and decision-making opportunities that must occur to accomplish objectives. Exercise Planning Meetings IPM Initial Planning Meeting Beginning of the exercise development phase Determine exercise scope and design requirements Identify exercise objectives and scenario variables MPM Midterm Planning Meeting Discuss exercise organization and staffing concepts Scenario and timeline development Develop the Master Scenario Events List (MSEL) FPM Final Planning Meeting Ensure that all elements of the exercise are ready for conduct No major changes to the exercise s design, scope, or supporting documentation Ensures that all logistical requirements have been met and outstanding issues have been identified and resolved 2017 HSS Inc. 7
Exercise Documents Operations-Based Discussion-Based Exercise Plan Master Scenario Events List Exercise & Evaluation Guide After-Action Report Improvement Plan Situation Manual Exercise & Evaluation Guide After-Action Report Improvement Plan Participant Feedback Form Participant Feedback Form Exercise Evaluation Guide (EEG) EEGs provide a consistent tool to guide exercise observation and data collection. EEGs are designed to accomplish several goals: Streamline data collection Enable thorough assessments of the participant organizations capability targets Support development of the AAR Provide a consistent process for assessing preparedness through exercises Help organizations map exercise results to exercise objectives, core capabilities, capability targets, and critical tasks for further analysis and assessment Participant Feedback Player Hot Wash: A Hot Wash provides an opportunity for exercise participants to discuss exercise strengths and areas for improvement immediately following the conduct of an exercise Should be led by an experienced facilitator who can ensure that the discussion remains brief and constructive The information gathered during a Hot Wash can be used during the AAR/IP process Participant Feedback Forms: Asks for input regarding observed strengths and areas for improvement Allows them to provide their insights into decisions made and actions taken Provide constructive criticism about design, control, or logistics of the exercise 2017 HSS Inc. 8
After Action Report/Improvement Plan After Action Report (AAR): The AAR is the document that summarizes key information related to evaluation Main focus is the analysis of core capabilities Includes an overview of performance related to each exercise objective and associated core capabilities Highlights strengths and areas for improvement Improvement Plan (IP): A qualitative assessment to identify potential corrective actions Corrective actions are concrete, actionable steps that are intended to resolve capability gaps Included within an AAR Using The Results Modifications to the Emergency Operations Plan (EOP) Modifications to training and education Retest modifications in next exercise to make sure it works Exercise Do s Communicate, communicate, communicate! Leadership: o Emails beginning at least 2-3 months out o Townhall meetings o Department-specific follow-up Staff: o Multiple email reminders o in-person department staff meetings o invite one-on-one follow-up Patients & Families: o At shift change/bedside report o On meal trays day before and day-of o Immediately before and after the exercise by safety controller 2017 HSS Inc. 9
Exercise Do s Communicate, communicate, communicate! Provide email and verbal contact with local law enforcement and/or dispatch Invite a law enforcement observer Share and test Communications Plan Discuss role of SimCellin lieu of emergency operators or dispatch to reduce chances of confusion Start and end allcommunications with this is an exercise Exercise Do s Conduct Planning Meetings Outline the role of participants: Controllers Facilitators Evaluators Players Observers Always outline the rules of engagement Open, low-stress, no-fault environment. Decisions are not precedent setting; consider different approaches and suggest improvements Issue identification is not as valuable as suggestions and recommended actions that could improve (mission area) efforts; problem-solving efforts should be the focus How do players/controllers deal with real-world emergencies or injuries William Castellano Senior Tactical Instructor, Healthcare Active Shooter Program HSS EM Solutions 877.477.2870 EMSolutions@hss-us.com www.hss-us.com 2017 HSS Inc. 10